Estate Planning Questionnaire

Date

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Occupation

Date of Birth

Place of Birth

Citizenship

Married

Yes

No

Engaged

Date of Marriage

Place of Marriage

Do you have a marriage contract?

Yes

No

Have you or your spouse been married before?

Yes

No

Support Obligations: Are you presently obliged to support any child or formerpartner?

Yes

No

Spouse's Full Name

First Last

Common Law

Yes

No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Occupation

Date of Birth

Place of Birth

Citizenship

Children

Full Name

Birthday

Address

Natural Adopted

(Please name all children whether you wish to benefit them or not. Note with a * any child of a former marriage of either spouse and indicate which spouse is the parent, with ** any child who may be disabled, and with *** any child who has died.) Use the plus button to add more rows.

Summary of Assets

Principal Residence

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Registered Owner's

Estimated Value

My Name

Spouse's Name

Both Names

Estimated Mortgage

My Name

Spouse's Name

Both Names

Balance Outstanding

My Name

Spouse's Name

Both Names

Mortgage Life Insured?

Yes

No

Equity

My Name

Spouse's Name

Both Nemes

Other Properties

Address

Registered Owner's

Total Estimated Value

My Name

Spouse's Name

Both Names

Estimated Mortgages

My Name

Spouse's Name

Both Names

Total Equity

My Name

Spouse's Name

Both Names

Stocks

My Name

Spouse's Name

Both Names

Bonds

My Name

Spouse's Name

Both Names

Mortgages

My Name

Spouse's Name

Both Names

Mutual Funds

My Name

Spouse's Name

Both Names

Term Deposits

My Name

Spouse's Name

Both Names

Pension Plans, Annuities, Profit Sharing, Stock Options or Similar Corporate or Other Plans:

Type

Company

Value - My Name

Value - Spouse's Name

Value - Both Names

IRAs, 401(k), 403(b):

Value - My Name

Value - Spouse's Name

Designated Beneficiary

Institution

Life Insurance:

Value - My Name

Value - Spouse's Name

Designated Beneficiary

Company/Owner

Cash in Financial Institution(s):

Name/Location of institution

Value - My Name

Value - Spouse's Name

Both Names

Safety Deposit Box No. and Location:

Describe any interest you may have in any proprietorships, partnerships or private companies:

Interest’s Name

Value - My Name

Value - Spouse's Name

Both Names

Personal Effects. etc:

Furniture/household goods

My Name

Spouse's Name

Both Names

Jewellery

My Name

Spouse's Name

Both Names

Boats

My Name

Spouse's Name

Both Names

Automobiles

My Name

Spouse's Name

Both Names

Automobiles

My Name

Spouse's Name

Both Names

Other, Specify

Asset

My Name

Spouse's Name

Both Names

Interests in existing estates or trusts - specify:

Description

My Name

Spouse's Name

Both Names

Total Assets

My Name

Spouse's Name

Both Names

SUMMARY OF DEBTS (other than mortgages previously noted)

Creditor Life insured?

Yes

No

Creditors

Debt

My Name

Spouse's Name

Both Names

SAFEKEEPING OF DOCUMENTS (Will / Power of Attorney / Asset Details)

Instructions to lawyer:

WILL PARTICULARS:

Executor(s)

Full Name

Address

Occupation

Relationship

Phone Number

Alternate Executor(s)

Full Name

Address

Occupation

Relationship

Phone Number

Guardian(s)

Full Name

Address

Occupation

Relationship

Phone Number

Alternate Guardian(s)

Full Name

Address

Occupation

Relationship

Phone Number

Household Goods, Personal Effects, Jewellery, Automobiles, etc:

State if you have any specific articles you wish to gift to any particular person(s) and provide full name and address and relationship of any such beneficiary-use Section F if more space is required.

Cash Legacies:

Do you wish to leave any cash legacies (gifts) to any relatives, others or charities? (provide full name, address and relationship of any such beneficiary)

Trust Fund(s) or custodianships:

Do you wish to provide a trust fund?

Yes

No

(i.e. for a mentally challenged child during his/her lifetime)

Details

Disposition of Residue:

Will your spouse receive the residue if he/she survives you?

Yes

No

If your spouse fails to survive you, do you wish to leave your estate to your children?

Yes

No

If your children are minors at what age(s) do you wish them to receive their share of your estate?

Please enter a number from 0 to 100.

If any child fails to survive to that age, do you wish his/her children, if any, to receive that share of your estate?

Yes

No

If no spouse or child survives you, who do you wish to receive the residue of your estate?

If instructions are other than those outlined above, list your instructions below (i.e. friends, charities, etc.)

Do you have memorial/funeral or burial wishes which you would like mentioned in your Will and, if so, what wishes?

(i.e. cremation, simple funeral, family plot, prepaid funeral)

Do you wish to limit the investment discretion of your trustees?

Trustee Compensation: If your executor or trustee is an individual already named in the will as receiving some benefit, is this benefit in addition to or in substitution for any compensation to the individual executor or trustee?

OTHER COMMENTS OR INSTRUCTIONS:

Prepared By

Date